The HLA class II allele DRB1*1501 is over-represented in patients with idiopathic pulmonary fibrosis

Background: Idiopathic pulmonary fibrosis (IPF) is a progressive and medically refractory lung disease with a grim prognosis. Although the etiology of IPF remains perplexing, abnormal adaptive immune responses are evident in many afflicted patients. We hypothesized that perturbations of human leukocyte antigen (HLA) allele frequencies, which are often seen among patients with immunologic diseases, may also be present in IPF patients. Methods/Principal Findings: HLA alleles were determined in subpopulations of IPF and normal subjects using molecular typing methods. HLA-DRB1*15 was over-represented in a discovery cohort of 79 Caucasian IPF subjects who had lung transplantations at the University of Pittsburgh (36.7%) compared to normal reference populations. These findings were prospectively replicated in a validation cohort of 196 additional IPF subjects from four other U.S. medical centers that included both ambulatory patients and lung transplantation recipients. High-resolution typing was used to further define specific HLA-DRB1*15 alleles. DRB1*1501 prevalence in IPF subjects was similar among the 143 ambulatory patients and 132 transplant recipients (31.5% and 34.8%, respectively, p = 0.55). The aggregate prevalence of DRB1*1501 in IPF patients was significantly greater than among 285 healthy controls (33.1% vs. 20.0%, respectively, OR 2.0; 95%CI 1.3-2.9, p = 0.0004). IPF patients with DRB1*1501 (n = 91) tended to have decreased diffusing capacities for carbon monoxide (DLCO) compared to the 184 disease subjects who lacked this allele (37.8±1.7% vs. 42.8±1.4%, p = 0.036). Conclusions/Significance: DRB1*1501 is more prevalent among IPF patients than normal subjects, and may be associated with greater impairment of gas exchange. These data are novel evidence that immunogenetic processes can play a role in the susceptibility to and/or manifestations of IPF. Findings here of a disease association at the HLA-DR locus have broad pathogenic implications, illustrate a specific chromosomal area for incremental, targeted genomic study, and may identify a distinct clinical phenotype among patients with this enigmatic, morbid lung disease

A model of collaborative innovation between local government and tourism operators

[EN] This research proposes a framework for collaborative innovation in a public private partnership by applying techniques that combine quantitative data collection and qualitative depth. It proposes a collaborative model that looks to provide competitive advantage by improving tourist services from two perspectives: from the core of public administration, and from the private tourist sector perspective.Pons Morera, C.; Canós Darós, L.; Gil Pechuán, I. (2017). A model of collaborative innovation between local government and tourism operators. SERVICE BUSINESS. AN INTERNATIONAL JOURNAL. 1-26. doi:10.1007/s11628-017-0341-xS126Anderberg MR (1973) Cluster analysis for applications. Academic Press, New YorkAugustyn K (2000) Performance of tourism partnerships: a focus on York. Tour Manag 2:341–351Aziri B, Nedelea A (2013) Business strategies in tourism. Ecoforum 2(1):9Baglieri D, Consoli R (2009) Collaborative innovation in tourism: managing virtual communities. TQM J 21(4):353–364Barbero MI (2009) Métodos de elaboración de escalas. UNED, MadridBeaumont N, Dredge D (2010) Local tourism governance: a comparison of three network approaches. J Sustain Tourism 18(1):7–28Beritelli P, Bieger T, Laesser C (2007) Destination governance: Using corporate governance theories as a foundation for effective destination management. J Travel Res 46:96–107Bigné JE, Aldás J, Küster I, Vila N (2002) Estableciendo los determinantes de la fidelidad del cliente: Un estudio basado en técnicas cualitativas. Investigación y Mark 77:58–62Bruntland GH (1987) Our common future. http://www.un-documents.net/our-common-future.pdf . Consulted in 2016Buch EB, Cabaleiro R (2011) Hacia la determinación de la condición financiera de la administración publica local. Aplicación a los municipios de la comunidad autónoma de Galicia. Academia, Revista latinoamericana de administración, No. 47, pp. 43–60Burke JG, O’Campo P, Peak GL, Gielen AC, McDonnell KA, Trochim WM (2005) An introduction to concept mapping as a participatory public health research method. Qual Health Res 15(10):1392–1410Bustelo C, García-Morales E (2008) Administración electrónica y gestión documental. Consideraciones a la luz de la ley para el acceso electrónico de los ciudadanos a los servicios públicos. El profesional de la información. Enero-febrero 17(1):106–111Caffyn A, Jobbins G (2003) Governance capacity and stakeholder interactions in the development and management of coastal tourism: examples from Morocco and Tunisia. J Sustain Tourism 11(2):224–245Carlisle S, Kunc M, Jones E, Tiffin S (2013) Supporting innovation for tourism development through multi-stakeholder approaches: experiences from Africa. Tour Manag 35:59–69Clavero J, Codina M, Pérez A, Serrat-Brustenga M (2009) Estudio de caso de servicio de préstamo de libros electrónicos. El profesional de la información. Marzo-abril 18(2):237–241Czernek K (2013) Determinants of cooperation in a tourist region. Ann Tourism Res 40:83–104Dinica V (2009) Governance for sustainable tourism: a comparison of international and dutch visions. Journal of Sustainable Tourism. 17(5):583–603Dredge D, Whitford M (2011) Event tourism governance and the public sphere. J Sustain Tourism 19(4-5):479–499European Directive 2006/7/EC. Bathing Water. http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2006:064:0037:0051:EN:PDF . Consulted in 2016Everitt B (1980) Cluster analysis. New York, NY, Halsted Press, a Division of John Wiley and SonsFernández O (1991) El análisis de Cluster: Aplicación, interpretación y validación. Papers 37:65–76Foundation for Environmental Quality of the European Union. http://www.blueflag.org/menu/awarded-sites/2014/northern-hemisphere/spain-2/List/Beaches . Consulted in 2016Freeman RE, McVea J (1984) A stakeholder approach to strategic management. Pitman, BostonGil-Lafuente AM, Kyun-Oh Y (2012) Incidencia de las inversiones de la administración pública sobre el desarrollo turístico de una ciudad. Revista Venezolana de Gestión Pública. Enero-Diciembre 3(3):81–109Gil-Pechuán I, Conesa-García M, Navarro-García A (2014) Concept mapping to improve higher education. Innovation and Teaching Technologies. ISBN: 978-3-319-04824-6. pp. 61–73Granovetter M (1985) Economic action and social structure: the problem of embeddedness. Am J Sociol 91(3):481Greenwood J (1993) Business interest groups in tourism governance. Tourism Manag 14:335–348Gulati R (1995) Social structure and alliance formation patterns: a longitudinal analysis. Adm Sci Q 40:619–653Henao-Betancur PA, Echeverri-Farley OM, Zartha-Sossa JW (2013) Metodología web para la formulación e implementación de estrategias de innovación en empresas. Rev Gestión de las Personas y Tecnol 16:6Hodge GA, Greve C (2017) On public-private partnership performance: a contemporary review. Public Works Manag Policy 22(1):55–78Hultman J, Hall CM (2012) Tourism place-Making governance of locality in Sweden. Ann Tourism Res 39(2):547–570Khattri N, Miles MB (1994) Cognitive mapping: a review and working guide. Center Policy Res, SparkhillKlodiana G, Dorina K, Engjellushe Z (2012) The role of local government in sustainable development. AUDOE. 8(2):139–155León JA, Zapico F (2003) Usos prácticos sobre la política electrónica en los servicios públicos: el caso de Extremadura. El profesional de la información. Mayo-junio 12(3):232–236Marinao E, Chasco C (2012) Trust in tourist destinations. the role of local inhabitants and institutions. Academia, Revista latinoamericana de administración 51:27–47Marzo-Roselló R, Peris-Pérez P, Ferris-Oñate, Sánchez-Lacuesta J, Matínez-Gómez L, Olaso-Melis J, Garcés-Pérez L, Primo-Capella VJ (2013) La experiencia turística en la ciudad de Valencia. Rev de Biomec 59:63–66Menon S, Manoj E (2014) Public private partnerships in tourism- a case study of Kerala Travel Mart. Afr J Hosp Tour Leisure 3(2):1–7Miranda-Gumucio L, Gil-Pechuán I, Palacios-Marqués D (2013) An exploratory study of the determinants of switching and loyalty in prepaid cell phone users. An application of concept mapping. Serv Bus 7(4):603–622Miret-Pastor L, Segarra-Oña MV (2011) Estudio del clúster turístico de Benidorm a través de indicadores de aglomeración y especialización. Renovación de destinos turísticos consolidados, pp 69–86Miret-Pastor L, Segarra-Oña MV, Hervás-Oliver JL (2009) Un análisis sobre la concentración espacial en el turismo valenciano. Congreso de la Asociación Española de Ciencia Regional. XXXV Reunión de estudios regionales, ValenciaMoscardo G (2011) Exploring social representations of tourism planning: issues for governance. J Sustain Tour 19(4-5):423–436Muñoz-Cañavate A, Chaín Navarro C (2004) La administración local española en internet: estudio cuantitativo de la evolución de los sistemas de información web de los ayuntamientos (1997–2002). Ciencias de la Inf 35(1):43–55Nabitz U, Severens P, Brink WVD, Jansen P (2007) Improving the EFQM model: an empirical study on model development and theory building using concept mapping. Total Qual Manag 12(1):69–81National and Integral Tourism Plan (2012–2015) http://www.minetur.gob.es/turismo/es-ES/PNIT/Documents/Plan%20Nacional%20e%20Integral%20de%20Turismo%20(PNIT)%202012-2015.pdf . Consulted in 2016Nicholson J, Orr K (2016) Local government partnership working: a space odyssey. Or, journeys through the dilemmas of public and private sector boundary-spanning actors. Policy Politics 44(2):269–287Nordin S, Svensson B (2007) Innovative destination governance: the Swedish ski resort of Åre. Entrepr Innov 8(1):53–66Nunkoo R (2015) Tourism development and trust in local government. Tour Manag 46:623–634Pechlaner H, Tschurtschenthaler P (2003) Tourism policy, tourism organisations and change management in Alpine regions and destinations: a european perspective. Curr Issues Tour 6(6):508–539Pfeffer J, Salancik G (1978) The external control of organizations: a resource-dependence perspective. Harper and Row, New YorkPorter ME (1990) The competitive advantage of nations. Harv Bus Rev 68(2):73–93Prahalad CK, Hamel G (1990) The core competence of the corporation. Harv Bus Rev 68(3):79–91Queiroz F, Rastrollo-Horrillo MA (2015) State of art in tourist destination governance. Tour Manag Stud 11(2):47–55. doi: 10.18089/tms.2015.11206Rodríguez MP, López AM, Ortiz D (2010) Implementing the balanced scorecard in public sector agencies: An experience in municipal sport services. Acad Rev latinoam de adm 45:116–139Rooter report (2010) La innovación en servicios en España. www.rooter.es . Consulted in 2016Rosas SR (2005) Concept mapping as a technique for program theory development: an illustration using family support programs. Am J Eval 26(3):389–401Rosas SR, Camphausen LC (2007) The use of concept mapping for scale development and validation in evaluation. Eval Progr Plann 30:125–135Santos M, Ferreira AM, Costa C (2014) Influential factors in the competitiveness of mature tourism destinations. Tour Manag Stud 10(1):73–81Selin S, Chavez D (1994) Characteristics of successful tourism partnerships: a multiple case study design. J Park Recreat Adm 12(2):51–61Selin S, Chavez D (1995) Developing an evolutionary tourism partnership model. Ann Tour Res 22(4):844–856Simpson B (1994) How do women scientists perceive their own career development? Int J Career Manag 6(1):19–27Soler-López MC (2013) Calidad y Rendimiento de Sitios Web de e-Government. Aplicación a la Administración Local. Doctoral thesis. Murcia UniversitySpanish Tourism Plan Horizon (2020) pp. 24 and 43. http://static.hosteltur.com/web/uploads/2011/10/Plan_de_Turismo_Espaol_Horizonte_2020.pdf . Consulted in 2016Toral SL, Barrero F, Martínez MR, Gallardo S, Cortés FJ (2006) Determinación de las variables de diseño en el desarrollo de una herramienta de e-learning. Pixel-Bit, Rev de medios y edu 27:99–113Torres L, Pina V (2001) Public–private partnership and private finance initiatives in the EU and Spanish local governments. Eur Account Rev 10:601–619Trochim WMK (1989) An introduction to concept mapping for planning and evaluation. Eval Progr Plann 12(1):1–16Trochim WMK, Linton R (1986) Conceptualization for planning and evaluation. Eval Progr Plann 9(4):289–308United Nations World Tourism Organization (2005) Making tourism more sustainable. A guide for policy makers, UNEP and UNWTO, pp 11–12. http://sdt.unwto.org/content/about-us-5United Nations World Tourism Organization (2015) UNWTO tourism highlights, p 6. http://www.e-unwto.org/doi/pdf/10.18111/9789284416899Velasco GM (2007) Gestión de destinos: ¿Gobernabilidad del turismo o gobernanza del destino?. Ministerio de educación y ciencia de España. Plan nacional de I + D + I (2004–2007)Wang Y (2008) Collaborative destination marketing: understanding the dynamic process. J Travel Res 47(2):151–166Wang Y, Fesenmaier RD (2007) Collaborative destination marketing: a case study of Elkhart county, Indiana. Tour Manag 28:863–875Wang C, Honggang X (2014) The role of local government and the private sector in China’s tourism industry. Tour Manag 45:95–105Williamson OE (1975) Markets and hierarchies: analysis and antitrust implications. The Free Press, New YorkWood DJ, Gray B (1991) Towards a comprehensive theory of collaboration. J Appl Behav Sci 27:139–162World Travel & Tourism Council (2016) Economic Impact 2016 Spain, p 3. http://www.wttc.org/-/media/files/reports/economic%20impact%20research/countries%202016/spain2016.pdf . Consulted in 2016Zapata MJ, Hall CM (2012) Public–private collaboration in the tourist sector: balancing legitimacy and effectiveness in local tourism partnerships. The Spanish case. J Policy Res Tour Leisure Events 4(1):61–8

Factors Influencing Receipt of Iron Supplementation by Young Children and their Mothers in Rural India: Local and National Cross-Sectional Studies

<p>Abstract</p> <p>Background</p> <p>In India, 55% of women and 69.5% of preschool children are anaemic despite national policies recommending routine iron supplementation. Understanding factors associated with receipt of iron in the field could help optimise implementation of anaemia control policies. Thus, we undertook 1) a cross-sectional study to evaluate iron supplementation to children (and mothers) in rural Karnataka, India, and 2) an analysis of all-India rural data from the National Family Health Study 2005-6 (NFHS-3).</p> <p>Methods</p> <p>All children aged 12-23 months and their mothers served by 6 of 8 randomly selected sub-centres managed by 2 rural Primary Health Centres of rural Karnataka were eligible for the Karnataka Study, conducted between August and October 2008. Socioeconomic and demographic data, access to health services and iron receipt were recorded. Secondly, NFHS-3 rural data were analysed. For both studies, logistic regression was used to evaluate factors associated with receipt of iron.</p> <p>Results</p> <p>The Karnataka Study recruited 405 children and 377 of their mothers. 41.5% of children had received iron, and 11.5% received iron through the public system. By multiple logistic regression, factors associated with children's receipt of iron included: wealth (Odds Ratio (OR) 2.63 [95% CI 1.11, 6.24] for top vs bottom wealth quintile), male sex (OR 2.45 [1.47, 4.10]), mother receiving postnatal iron (OR 2.31 [1.25, 4.28]), mother having undergone antenatal blood test (OR 2.10 [1.09, 4.03]); Muslim religion (OR 0.02 [0.00, 0.27]), attendance at Anganwadi centre (OR 0.23 [0.11, 0.49]), fully vaccinated (OR 0.33 [0.15, 0.75]), or children of mothers with more antenatal health visits (8-9 visits OR 0.25 [0.11, 0.55]) were less likely to receive iron. Nationally, 3.7% of rural children were receiving iron; this was associated with wealth (OR 1.12 [1.02, 1.23] per quintile), maternal education (compared with no education: completed secondary education OR 2.15 [1.17, 3.97], maternal antenatal iron (2.24 [1.56, 3.22]), and child attending an Anganwadi (OR 1.47 [1.20, 1.80]).</p> <p>Conclusion</p> <p>In rural India, public distribution of iron to children is inadequate and disparities exist. Measures to optimize receipt of government supplied iron to all children regardless of wealth and ethnic background could help alleviate anaemia in this population.</p

Lessons learned from implementation of a demonstration program to reduce the burden of anemia and hookworm in women in Yen Bai Province, Viet Nam

Background Iron deficiency, anemia and hookworm disease are important public health problems for women of reproductive age living in developing countries and affect the health of newborns and infants. Iron supplementation and deworming treatment are effective in addressing these problems in both pregnant and non-pregnant women. Daily iron supplementation and deworming after the first trimester is recommended for pregnant women although these programs usually do not operate efficiently or effectively. Weekly iron-folic acid supplementation and regular deworming for non-pregnant women may be a viable approach for improving iron status and preventing anemia during the reproductive years. Addressing these diseases at a population level before women become pregnant could significantly improve women's health before and during pregnancy, as well as their infants' growth and development. Methods and Results This paper describes the major processes undertaken in a demonstration intervention of preventive weekly iron-folic acid supplementation with regular deworming for all 52,000 women aged 15–45 years in two districts of Yen Bai province, in northern Viet Nam. The intervention strategy included extensive consultation with community leaders and village, commune, district and provincial health staff, and training for village health workers. Distribution of the drugs was integrated with the existing health service infrastructure and the village health workers were the direct point of contact with women. Iron-folic acid tablets and deworming treatment were provided free of charge from May 2006. An independent Vietnamese NGO was commissioned to evaluate compliance and identify potential problems. The program resulted in effective distribution of iron-folic acid tablets and deworming treatment to all villages in the target districts, with full or partial compliance of 85%. Conclusion Training for health staff, the strong commitment of all partners and the use of appropriate educational materials led to broad support for weekly iron-folic acid supplementation and high participation in the regular deworming days. In March 2008 the program was expanded to all districts in the province, a target population of approximately 250,000 WRA, and management was handed over to provincial authorities

A free weekly iron-folic acid supplementation and regular deworming program is associated with improved hemoglobin and iron status indicators in Vietnamese women

Background Anemia due to iron deficiency is recognized as one of the major nutritional deficiencies in women and children in developing countries. Daily iron supplementation for pregnant women is recommended in many countries although there are few reports of these programs working efficiently or effectively. Weekly iron-folic acid supplementation (WIFS) and regular deworming treatment is recommended for non-pregnant women living in areas with high rates of anemia. Following a baseline survey to assess the prevalence of anemia, iron deficiency and soil transmitted helminth infections, we implemented a program to make WIFS and regular deworming treatment freely and universally available for all women of reproductive age in two districts of a province in northern Vietnam over a 12 month period. The impact of the program at the population level was assessed in terms of: i) change in mean hemoglobin and iron status indicators, and ii) change in the prevalence of anemia, iron deficiency and hookworm infections. Method Distribution of WIFS and deworming were integrated with routine health services and made available to 52,000 women. Demographic data and blood and stool samples were collected in baseline, and three and 12-month post-implementation surveys using a population-based, stratified multi-stage cluster sampling design. Results The mean Hb increased by 9.6 g/L (95% CI, 5.7, 13.5, p < 0.001) during the study period. Anemia (Hb<120 g/L) was present in 131/349 (37.5%, 95% CI 31.3, 44.8) subjects at baseline, and in 70/363 (19.3%, 95% CI 14.0, 24.6) after twelve months. Iron deficiency reduced from 75/329 (22.8%, 95% CI 16.9, 28.6) to 33/353 (9.3%, 95% CI 5.7, 13.0) by the 12-mnth survey, and hookworm infection from 279/366 (76.2%,, 95% CI 68.6, 83.8) to 66/287 (23.0%, 95% CI 17.5, 28.5) over the same period. Conclusion A free, universal WIFS program with regular deworming was associated with reduced prevalence and severity of anemia, iron deficiency and h

Developing a conceptual framework for an evaluation system for the NIAID HIV/AIDS clinical trials networks

Globally, health research organizations are called upon to re-examine their policies and practices to more efficiently and effectively address current scientific and social needs, as well as increasing public demands for accountability

Uncovering the Prevalence and Diversity of Integrating Conjugative Elements in Actinobacteria

Horizontal gene transfer greatly facilitates rapid genetic adaptation of bacteria to shifts in environmental conditions and colonization of new niches by allowing one-step acquisition of novel functions. Conjugation is a major mechanism of horizontal gene transfer mediated by conjugative plasmids and integrating conjugative elements (ICEs). While in most bacterial conjugative systems DNA translocation requires the assembly of a complex type IV secretion system (T4SS), in Actinobacteria a single DNA FtsK/SpoIIIE-like translocation protein is required. To date, the role and diversity of ICEs in Actinobacteria have received little attention. Putative ICEs were searched for in 275 genomes of Actinobacteria using HMM-profiles of proteins involved in ICE maintenance and transfer. These exhaustive analyses revealed 144 putative FtsK/SpoIIIE-type ICEs and 17 putative T4SS-type ICEs. Grouping of the ICEs based on the phylogenetic analyses of maintenance and transfer proteins revealed extensive exchanges between different sub-families of ICEs. 17 ICEs were found in Actinobacteria from the genus Frankia, globally important nitrogen-fixing microorganisms that establish root nodule symbioses with actinorhizal plants. Structural analysis of ICEs from Frankia revealed their unexpected diversity and a vast array of predicted adaptive functions. Frankia ICEs were found to excise by site-specific recombination from their host's chromosome in vitro and in planta suggesting that they are functional mobile elements whether Frankiae live as soil saprophytes or plant endosymbionts. Phylogenetic analyses of proteins involved in ICEs maintenance and transfer suggests that active exchange between ICEs cargo-borne and chromosomal genes took place within the Actinomycetales order. Functionality of Frankia ICEs in vitro as well as in planta lets us anticipate that conjugation and ICEs could allow the development of genetic manipulation tools for this challenging microorganism and for many other Actinobacteria

The use of genomic signature distance between bacteriophages and their hosts displays evolutionary relationships and phage growth cycle determination

<p>Abstract</p> <p>Background</p> <p>Bacteriophage classification is mainly based on morphological traits and genome characteristics combined with host information and in some cases on phage growth lifestyle. A lack of molecular tools can impede more precise studies on phylogenetic relationships or even a taxonomic classification. The use of methods to analyze genome sequences without the requirement for homology has allowed advances in classification.</p> <p>Results</p> <p>Here, we proposed to use genome sequence signature to characterize bacteriophages and to compare them to their host genome signature in order to obtain host-phage relationships and information on their lifestyle. We analyze the host-phage relationships in the four most representative groups of Caudoviridae, the dsDNA group of phages. We demonstrate that the use of phage genomic signature and its comparison with that of the host allows a grouping of phages and is also able to predict the host-phage relationships (lytic <it>vs</it>. temperate).</p> <p>Conclusions</p> <p>We can thus condense, in relatively simple figures, this phage information dispersed over many publications.</p

The global distribution of fatal pesticide self-poisoning: Systematic review

<p>Abstract</p> <p>Background</p> <p>Evidence is accumulating that pesticide self-poisoning is one of the most commonly used methods of suicide worldwide, but the magnitude of the problem and the global distribution of these deaths is unknown.</p> <p>Methods</p> <p>We have systematically reviewed the worldwide literature to estimate the number of pesticide suicides in each of the World Health Organisation's six regions and the global burden of fatal self-poisoning with pesticides. We used the following data sources: Medline, EMBASE and psycINFO (1990–2007), papers cited in publications retrieved, the worldwide web (using Google) and our personal collections of papers and books. Our aim was to identify papers enabling us to estimate the proportion of a country's suicides due to pesticide self-poisoning.</p> <p>Results</p> <p>We conservatively estimate that there are 258,234 (plausible range 233,997 to 325,907) deaths from pesticide self-poisoning worldwide each year, accounting for 30% (range 27% to 37%) of suicides globally. Official data from India probably underestimate the incidence of suicides; applying evidence-based corrections to India's official data, our estimate for world suicides using pesticides increases to 371,594 (range 347,357 to 439,267). The proportion of all suicides using pesticides varies from 4% in the European Region to over 50% in the Western Pacific Region but this proportion is not concordant with the volume of pesticides sold in each region; it is the pattern of pesticide use and the toxicity of the products, not the quantity used, that influences the likelihood they will be used in acts of fatal self-harm.</p> <p>Conclusion</p> <p>Pesticide self-poisoning accounts for about one-third of the world's suicides. Epidemiological and toxicological data suggest that many of these deaths might be prevented if (a) the use of pesticides most toxic to humans was restricted, (b) pesticides could be safely stored in rural communities, and (c) the accessibility and quality of care for poisoning could be improved.</p